In hypersonic boundary layers,the optimal disturbance is notably caused by normalmode instabilities,such as Mack second mode.However,recent experimental and numerical efforts have demonstrated the dominance of nonmoda...In hypersonic boundary layers,the optimal disturbance is notably caused by normalmode instabilities,such as Mack second mode.However,recent experimental and numerical efforts have demonstrated the dominance of nonmodal growth in hypersonic flows with the presence of moderate nose bluntness.In this study,resolvent analysis and parabolized stability equation analysis are performed to investigate the instabilities over a blunt-tip wedge.Main parameters include Mach number 5.9,unit Reynolds number 91.5×10~6/m,half wedge angle 5°,and nose radii ranging from 2.54 mm to 15.24 mm.Two novel growth patterns of travelling waves are identified to compete,whose nature is the intersection of the energy gain of optimal and sub-optimal disturbances.Pattern A with large spanwise wavelengths has the signature of slow energy amplification over a long distance which concentrates in the entropy layer.By contrast,pattern B with relatively small spanwise wavelengths presents rapid transient growth inside the boundary layer.A systematic study is performed on the growth/attenuation mechanism of disturbance patterns and the effects of wall temperature and nose radius.Wall cooling is found to be an alternative control strategy aimed at nonmodal instabilities.The receptivity to slow acoustic waves is considered when the effect of bluntness is studied.An estimated amplitude response favorably reproduces the reversal-like phenomenon.The lift-up/Orr mechanism analysis provides an explanation of energy growth for nonmodal responses.展开更多
The primary Mach Reflection(MR)and pressure/heating loads on V-shaped Blunt Leading Edges(VBLEs)with variable elliptic cross-sections and conic crotches are theoretically investigated in this study.The simplified cont...The primary Mach Reflection(MR)and pressure/heating loads on V-shaped Blunt Leading Edges(VBLEs)with variable elliptic cross-sections and conic crotches are theoretically investigated in this study.The simplified continuity method is used to forecast the shock configurations.The theoretical predictions and the numerical simulations for the Mach stem and the triple point as well as the curved shock accord well.Based on the theoretical model,an analysis of the impact of the axial ratio a/b of the cross-sectional shape and the eccentricity e of the crotch sweep path on shock structures is carried out.The shock configurations obtained from the theoretical model enable the derivation of the transition boundaries between the primary MR and the same family Regular Reflection(sRR).It is found that the increase of a/b and e can both facilitate the primary MR to sRR transition.The resulting transition and the corresponding generation of the wall pressure and heat flux are then investigated.The results indicate that higher values of the ratio a/b can significantly reduce the wall pressure and heating loads by inducing the primary MR to sRR transition.Conversely,the increase in the eccentricity e results in increased loads,despite causing the same transition.展开更多
Vortex-induced vibration of hydrofoils is concerned with structural safety and noise level in hydraulic machinery and marine engineering.The research on vibration characteristics under different operating conditions i...Vortex-induced vibration of hydrofoils is concerned with structural safety and noise level in hydraulic machinery and marine engineering.The research on vibration characteristics under different operating conditions is significant.In this study,numerical simulations are conducted to investigate the vortex-induced vibration responses of an elastically suspended hydrofoil with blunt trailing edge in pitch direction.The work studies the effects of four parameters,namely the structural natural frequency,mass ratio,initial attack angle,and Reynolds number on vibration characteristics,with special emphasis on frequency lock-in.Results indicate that as the structural natural frequency changes,the vibration amplitude may increase substantially within a certain frequency range,in which the vortex shedding frequency locks into the structural natural frequency,and frequency lock-in occurs.In addition,with increasing the mass ratio,the frequency range of lock-in becomes narrower,and both the upper and lower thresholds decrease.As the initial attack angle increases from 0◦to 6◦,the lock-in range gets reduced.Over the three Reynolds numbers(6×10^(5),9×10^(5),and 12×10^(5)),the lock-in range remains virtually unchanged.Moreover,for a certain structural natural frequency,modifying the mass ratio,initial attack angle,and Reynolds number could effectively suppress the vibration amplitude.展开更多
Hydraulic fracture is important in unconventional oil and gas exploration.During the propagation of the hydraulic fracture,the crack tip is blunted due to the development of the process zone in the near-tip area.In th...Hydraulic fracture is important in unconventional oil and gas exploration.During the propagation of the hydraulic fracture,the crack tip is blunted due to the development of the process zone in the near-tip area.In this study,the blunting of the hydraulic fracture in polymethyl methacrylate specimens due to multi-timescale stress concentration is investigated.The ratio of the initiation toughness to the arrest toughness of the blunted hydraulic fracture is measured using both the dynamic and the static methods.Results show that a hydraulic fracture can be blunted with the time span of stress concentration from 1 ms to 600 s.It is also shown that the blunting of hydraulic fracture is a highly localized process.The morphology of the blunted crack depends on the stress distribution in the vicinity of the crack tip.展开更多
The mass loss and nose blunting of a projectile during high-speed deep penetration into concrete target may cause structural destruction and ballistic trajectory instability of the penetrator,obviously reducing the pe...The mass loss and nose blunting of a projectile during high-speed deep penetration into concrete target may cause structural destruction and ballistic trajectory instability of the penetrator,obviously reducing the penetration efficiency of penetrator.Provided that the work of friction between projectile and target is totally transformed into the heat to melt penetrator material at its nose surface,an engineering model is established for the mass loss and nose-blunting of the ogive-nosed projectile.A dimensionless formula for the relative mass loss of projectile is obtained by introducing the dimensionless impact function I and geometry function N of the projectile.The critical value V c0of the initial striking velocity is formulated,and the mass loss of projectile tends to increase weakly nonlinearly with I/N when V0〉V c0,whilst the mass loss is proportional to the initial kinetic energy of projectile when V0展开更多
The paper presents finite element modeling of crack tip blunting for numerical estimation of fracture parameter of a Mode I crack, in weak alloy steel, which is near and normal to the interface of elastically identica...The paper presents finite element modeling of crack tip blunting for numerical estimation of fracture parameter of a Mode I crack, in weak alloy steel, which is near and normal to the interface of elastically identical but stronger maraging steel. The bimetallic body is subjected to monotonic load in K dominated regime. Crack tip yield zone across the interface, treated as Dugdale’s cohesive zone, is isolated from the bimetallic domain and is modeled alone under the action of respective cohesive stress over yield zones for obtaining the contribution of mismatch between yield strength of the steels in crack energy release rate component, Jinterface. Effect of far field load on Jinterface is found separately from a theoretical model. Numerical and theoretical results of Jinterface are in good agreement.展开更多
The blunting line equation is very important in J-integral testing because of its indispensability in the determination of valid data and JIC value. The blunting line equation in current standard has had a larger rela...The blunting line equation is very important in J-integral testing because of its indispensability in the determination of valid data and JIC value. The blunting line equation in current standard has had a larger relative error in depiction of the crack blunting compared to the experimentally measured results. By analyzing the blunting process of the crack tip according to the D-B model, a new form of blunting line was obtained on the base of the path independence of J-integral, i.e., J=1.25(σs+Sf)/(1+n)·WSZ. Experimental results show that this equation is more precise to describe the crack blunting than those in current standards.展开更多
Through the establishment mathematical model and experimental verification, the course of blunting of hard alloy cutter blade for cutting chemical fiber have been studied. The result shows that the cutter blade sharpn...Through the establishment mathematical model and experimental verification, the course of blunting of hard alloy cutter blade for cutting chemical fiber have been studied. The result shows that the cutter blade sharpness would be greatly reduced in the course of fiber cutting as the initial edge radius and edge angle, the linear wear, and the notch depth of cutter blade are increased. The blunting of cutter blade in the course of fiber cutting can be divided into four stages. The reducing degree of the sharpness is different in different stages. The linear wear of cutter blade is almost negligible. The blunting of the cutter blade is directly related to the depth of notches generated on the cutting edge. The deeper the notch, the more the cutter blade sharpness would be decreased.展开更多
BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard t...BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard treatment for hemodynam-ically stable patients with splenic injuries.On the other hand,delayed splenic pseudoaneurysms can develop in any patient,and at present,there are no known risk factors that may reliably predict their occurrence.Furthermore,there is a lack of consensus regarding the most appropriate strategies for monitoring and mana-ging splenic injuries,especially lower-grade(I-III).AIM To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.METHODS We retrospectively analyzed patients who visited the Level I Trauma Center bet-ween January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.RESULTS Using the American Association for the Surgery of Trauma spleen injury scale,the splenic injuries were categorized into the following order based on severity:Grade I(n=57,17.6%),grade II(n=114,35.3%),grade III(n=89,27.6%),grade IV(n=50,15.5%),and grade V(n=13,4.0%).Of a total of 323 patients,35 underwent splenectomy and 126 underwent angioembolization.19 underwent delayed angioembolization,and 5 under-went both initial and delayed angioem-bolization.In 14 patients who had undergone delayed angioembolization,no extravasation or pseudoaneurysm was observed on the initial computed tomography scan.There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm,which can occur even in a grade I spleen injury or even 21 days after the injury.The mean detection time for a delayed pseudoaneurysm was 6.26±5.4(1-21,median:6,inter-quartile range:2-9)days.CONCLUSION We recommend regular follow-up computed tomography scans,including an arterial and portal venous phase,at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.展开更多
BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Ab...BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.展开更多
目的探讨儿童闭合性肝脏外伤的临床特点和诊治方法,总结儿童肝脏外伤的治疗经验。方法回顾性分析皖南医学院弋矶山医院小儿外科2014年4月至2024年6月收治的儿童闭合性肝脏外伤患者的临床资料,对保守治疗患儿治疗前后肝功能相关指标的检...目的探讨儿童闭合性肝脏外伤的临床特点和诊治方法,总结儿童肝脏外伤的治疗经验。方法回顾性分析皖南医学院弋矶山医院小儿外科2014年4月至2024年6月收治的儿童闭合性肝脏外伤患者的临床资料,对保守治疗患儿治疗前后肝功能相关指标的检验结果进行对比分析,并对诊治经验进行总结。结果本研究纳入闭合性肝脏外伤患儿21例,其中男10例,女11例。美国创伤外科协会(AAST)肝脏外伤分级(2018版):Ⅰ级5例,Ⅱ级11例,Ⅲ级3例,Ⅳ级1例,V级1例。21例闭合性肝脏外伤患儿中行保守治疗19例,1例AAST分级Ⅳ级伴血流动力学不稳定的患儿行肝脏修补术治疗,1例AAST分级V级患儿因肝脏严重损伤,入院后急诊手术抢救无效死亡。保守治疗前后患儿血红蛋白(Hb)[(116.74±15.36)g/L vs(125.79±9.72)g/L]、丙氨酸氨基转移酶(ALT)[256.00(173.00,521.00)U/L vs 46.00(24.00,61.00)U/L]、天门冬氨酸氨基转移酶(AST)[255.00(137.00,475.00)U/L vs 28.00(21.00,32.00)U/L]、AST线粉粒体同工酶(m-AST)[96.00(23.00,137.00)U/L vs 12.00(9.00,14.00)U/L]及总胆红素(TBIL)[15.15(9.76,17.64)U/L vs 5.97(4.77,10.24)U/L]比较,差异具有统计学意义(均P<0.05)。保守治疗和手术治疗的20例患儿均痊愈出院,随访未见出血、胆管狭窄等并发症发生。结论本研究通过对21例儿童闭合性肝脏外伤的临床特点和诊治方法进行分析,结果显示儿童肝脏右叶损伤多见,腹部体征明显,约3/4患儿为AAST分级Ⅰ、Ⅱ级损伤。对于AAST分级Ⅰ~Ⅲ级以及血流动力学稳定的闭合性肝脏外伤患儿,保守治疗是有效的;通过密切监测和合理管理,患儿的肝功能指标(Hb、ALT、AST等)均能显著改善。展开更多
基金supported by the Hong Kong Research Grants Council(Nos.15216621,15204322,25203721)the National Natural Science Foundation of China(No.12102377)。
文摘In hypersonic boundary layers,the optimal disturbance is notably caused by normalmode instabilities,such as Mack second mode.However,recent experimental and numerical efforts have demonstrated the dominance of nonmodal growth in hypersonic flows with the presence of moderate nose bluntness.In this study,resolvent analysis and parabolized stability equation analysis are performed to investigate the instabilities over a blunt-tip wedge.Main parameters include Mach number 5.9,unit Reynolds number 91.5×10~6/m,half wedge angle 5°,and nose radii ranging from 2.54 mm to 15.24 mm.Two novel growth patterns of travelling waves are identified to compete,whose nature is the intersection of the energy gain of optimal and sub-optimal disturbances.Pattern A with large spanwise wavelengths has the signature of slow energy amplification over a long distance which concentrates in the entropy layer.By contrast,pattern B with relatively small spanwise wavelengths presents rapid transient growth inside the boundary layer.A systematic study is performed on the growth/attenuation mechanism of disturbance patterns and the effects of wall temperature and nose radius.Wall cooling is found to be an alternative control strategy aimed at nonmodal instabilities.The receptivity to slow acoustic waves is considered when the effect of bluntness is studied.An estimated amplitude response favorably reproduces the reversal-like phenomenon.The lift-up/Orr mechanism analysis provides an explanation of energy growth for nonmodal responses.
基金support of the National Natural Science Foundation of China(Nos.U20A2069,12302389,12372295)the Natural Science Foundation of Fujian Province,China(No.2023J01046)。
文摘The primary Mach Reflection(MR)and pressure/heating loads on V-shaped Blunt Leading Edges(VBLEs)with variable elliptic cross-sections and conic crotches are theoretically investigated in this study.The simplified continuity method is used to forecast the shock configurations.The theoretical predictions and the numerical simulations for the Mach stem and the triple point as well as the curved shock accord well.Based on the theoretical model,an analysis of the impact of the axial ratio a/b of the cross-sectional shape and the eccentricity e of the crotch sweep path on shock structures is carried out.The shock configurations obtained from the theoretical model enable the derivation of the transition boundaries between the primary MR and the same family Regular Reflection(sRR).It is found that the increase of a/b and e can both facilitate the primary MR to sRR transition.The resulting transition and the corresponding generation of the wall pressure and heat flux are then investigated.The results indicate that higher values of the ratio a/b can significantly reduce the wall pressure and heating loads by inducing the primary MR to sRR transition.Conversely,the increase in the eccentricity e results in increased loads,despite causing the same transition.
基金the National Natural Science Foundation of China(Nos.52171316 and 51479116)。
文摘Vortex-induced vibration of hydrofoils is concerned with structural safety and noise level in hydraulic machinery and marine engineering.The research on vibration characteristics under different operating conditions is significant.In this study,numerical simulations are conducted to investigate the vortex-induced vibration responses of an elastically suspended hydrofoil with blunt trailing edge in pitch direction.The work studies the effects of four parameters,namely the structural natural frequency,mass ratio,initial attack angle,and Reynolds number on vibration characteristics,with special emphasis on frequency lock-in.Results indicate that as the structural natural frequency changes,the vibration amplitude may increase substantially within a certain frequency range,in which the vortex shedding frequency locks into the structural natural frequency,and frequency lock-in occurs.In addition,with increasing the mass ratio,the frequency range of lock-in becomes narrower,and both the upper and lower thresholds decrease.As the initial attack angle increases from 0◦to 6◦,the lock-in range gets reduced.Over the three Reynolds numbers(6×10^(5),9×10^(5),and 12×10^(5)),the lock-in range remains virtually unchanged.Moreover,for a certain structural natural frequency,modifying the mass ratio,initial attack angle,and Reynolds number could effectively suppress the vibration amplitude.
基金the support from the China National Science and Technology Major Project"Changning-Weiyuan shale gas development demonstration project"(2016ZX05062)the support from the China National Petroleum Corporation:"Research on Influencing Factors of Gas Hydrate Sand Production and Experimental Design"(No.CPETQ201921)。
文摘Hydraulic fracture is important in unconventional oil and gas exploration.During the propagation of the hydraulic fracture,the crack tip is blunted due to the development of the process zone in the near-tip area.In this study,the blunting of the hydraulic fracture in polymethyl methacrylate specimens due to multi-timescale stress concentration is investigated.The ratio of the initiation toughness to the arrest toughness of the blunted hydraulic fracture is measured using both the dynamic and the static methods.Results show that a hydraulic fracture can be blunted with the time span of stress concentration from 1 ms to 600 s.It is also shown that the blunting of hydraulic fracture is a highly localized process.The morphology of the blunted crack depends on the stress distribution in the vicinity of the crack tip.
基金supported by the National Outstanding Young Scientists Foundation of China(11225213)the Funds for Creative Research Groups of China(51321064)the National Natural Science Foundation of China(11172282 and 51378015)
文摘The mass loss and nose blunting of a projectile during high-speed deep penetration into concrete target may cause structural destruction and ballistic trajectory instability of the penetrator,obviously reducing the penetration efficiency of penetrator.Provided that the work of friction between projectile and target is totally transformed into the heat to melt penetrator material at its nose surface,an engineering model is established for the mass loss and nose-blunting of the ogive-nosed projectile.A dimensionless formula for the relative mass loss of projectile is obtained by introducing the dimensionless impact function I and geometry function N of the projectile.The critical value V c0of the initial striking velocity is formulated,and the mass loss of projectile tends to increase weakly nonlinearly with I/N when V0〉V c0,whilst the mass loss is proportional to the initial kinetic energy of projectile when V0
文摘The paper presents finite element modeling of crack tip blunting for numerical estimation of fracture parameter of a Mode I crack, in weak alloy steel, which is near and normal to the interface of elastically identical but stronger maraging steel. The bimetallic body is subjected to monotonic load in K dominated regime. Crack tip yield zone across the interface, treated as Dugdale’s cohesive zone, is isolated from the bimetallic domain and is modeled alone under the action of respective cohesive stress over yield zones for obtaining the contribution of mismatch between yield strength of the steels in crack energy release rate component, Jinterface. Effect of far field load on Jinterface is found separately from a theoretical model. Numerical and theoretical results of Jinterface are in good agreement.
文摘The blunting line equation is very important in J-integral testing because of its indispensability in the determination of valid data and JIC value. The blunting line equation in current standard has had a larger relative error in depiction of the crack blunting compared to the experimentally measured results. By analyzing the blunting process of the crack tip according to the D-B model, a new form of blunting line was obtained on the base of the path independence of J-integral, i.e., J=1.25(σs+Sf)/(1+n)·WSZ. Experimental results show that this equation is more precise to describe the crack blunting than those in current standards.
文摘Through the establishment mathematical model and experimental verification, the course of blunting of hard alloy cutter blade for cutting chemical fiber have been studied. The result shows that the cutter blade sharpness would be greatly reduced in the course of fiber cutting as the initial edge radius and edge angle, the linear wear, and the notch depth of cutter blade are increased. The blunting of cutter blade in the course of fiber cutting can be divided into four stages. The reducing degree of the sharpness is different in different stages. The linear wear of cutter blade is almost negligible. The blunting of the cutter blade is directly related to the depth of notches generated on the cutting edge. The deeper the notch, the more the cutter blade sharpness would be decreased.
文摘BACKGROUND The spleen is the most commonly injured solid organ in blunt abdominal trauma,and splenic pseudoaneurysm rupture is associated with a high risk of mortality.Nonoperative management has become the standard treatment for hemodynam-ically stable patients with splenic injuries.On the other hand,delayed splenic pseudoaneurysms can develop in any patient,and at present,there are no known risk factors that may reliably predict their occurrence.Furthermore,there is a lack of consensus regarding the most appropriate strategies for monitoring and mana-ging splenic injuries,especially lower-grade(I-III).AIM To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.METHODS We retrospectively analyzed patients who visited the Level I Trauma Center bet-ween January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.RESULTS Using the American Association for the Surgery of Trauma spleen injury scale,the splenic injuries were categorized into the following order based on severity:Grade I(n=57,17.6%),grade II(n=114,35.3%),grade III(n=89,27.6%),grade IV(n=50,15.5%),and grade V(n=13,4.0%).Of a total of 323 patients,35 underwent splenectomy and 126 underwent angioembolization.19 underwent delayed angioembolization,and 5 under-went both initial and delayed angioem-bolization.In 14 patients who had undergone delayed angioembolization,no extravasation or pseudoaneurysm was observed on the initial computed tomography scan.There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm,which can occur even in a grade I spleen injury or even 21 days after the injury.The mean detection time for a delayed pseudoaneurysm was 6.26±5.4(1-21,median:6,inter-quartile range:2-9)days.CONCLUSION We recommend regular follow-up computed tomography scans,including an arterial and portal venous phase,at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.
文摘BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.
文摘目的探讨儿童闭合性肝脏外伤的临床特点和诊治方法,总结儿童肝脏外伤的治疗经验。方法回顾性分析皖南医学院弋矶山医院小儿外科2014年4月至2024年6月收治的儿童闭合性肝脏外伤患者的临床资料,对保守治疗患儿治疗前后肝功能相关指标的检验结果进行对比分析,并对诊治经验进行总结。结果本研究纳入闭合性肝脏外伤患儿21例,其中男10例,女11例。美国创伤外科协会(AAST)肝脏外伤分级(2018版):Ⅰ级5例,Ⅱ级11例,Ⅲ级3例,Ⅳ级1例,V级1例。21例闭合性肝脏外伤患儿中行保守治疗19例,1例AAST分级Ⅳ级伴血流动力学不稳定的患儿行肝脏修补术治疗,1例AAST分级V级患儿因肝脏严重损伤,入院后急诊手术抢救无效死亡。保守治疗前后患儿血红蛋白(Hb)[(116.74±15.36)g/L vs(125.79±9.72)g/L]、丙氨酸氨基转移酶(ALT)[256.00(173.00,521.00)U/L vs 46.00(24.00,61.00)U/L]、天门冬氨酸氨基转移酶(AST)[255.00(137.00,475.00)U/L vs 28.00(21.00,32.00)U/L]、AST线粉粒体同工酶(m-AST)[96.00(23.00,137.00)U/L vs 12.00(9.00,14.00)U/L]及总胆红素(TBIL)[15.15(9.76,17.64)U/L vs 5.97(4.77,10.24)U/L]比较,差异具有统计学意义(均P<0.05)。保守治疗和手术治疗的20例患儿均痊愈出院,随访未见出血、胆管狭窄等并发症发生。结论本研究通过对21例儿童闭合性肝脏外伤的临床特点和诊治方法进行分析,结果显示儿童肝脏右叶损伤多见,腹部体征明显,约3/4患儿为AAST分级Ⅰ、Ⅱ级损伤。对于AAST分级Ⅰ~Ⅲ级以及血流动力学稳定的闭合性肝脏外伤患儿,保守治疗是有效的;通过密切监测和合理管理,患儿的肝功能指标(Hb、ALT、AST等)均能显著改善。
